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General NPI Number Information
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NPI Number | 1245359041
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Entity Type | Individual
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Provider Name | MICHAEL PHILLIP FRAGEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1615 S NORBURY AVE
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City | LOMBARD
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State | IL
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Zip | 60148-6182
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Country | US
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Telephone | 630-627-2511
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Fax | 847-510-0505
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Provider Business Mailing Address
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Address Line | 1615 S NORBURY AVE
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City | LOMBARD
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State | IL
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Zip | 60148-6182
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Country | US
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Telephone | 630-627-2511
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Fax | 847-510-0505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State | IL
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